Healthy Choices

Q&A: What you need to know about the Ebola outbreak

With the worst Ebola outbreak in history killing hundreds in Guinea, Liberia and Sierra Leone, one UC Davis epidemiologist is attempting to prevent similar crises from happening around the world by anticipating them before they take hold.

Since 2009, Dr. Jonna Mazet and her PREDICT project team have been mapping hot spots for zoonotic diseases – those that can be passed between animals and humans – with pandemic potential and bracing those areas for impact. Her research had identified west Africa as a high-risk area for Ebola before the outbreak started based on its human population density, its biodiversity, and the dangerous ways in which humans and wildlife were coming together, such as through the hunting and handling of monkeys, bats and other “bush meat.”

Ebola is believed to have originated in fruit bats, and jumped to a 2-year-old boy in Guinea last December. The current strain of the virus, Ebola Zaire, first appeared in Sudan and the Democratic Republic of Congo in 1976 and has caused minor outbreaks in communities throughout Africa since then – but never in the region currently affected or to this degree. Health officials in Guinea, Liberia and Sierra Leone did not recognize the virus until March, Mazet said, at which point the death toll was already climbing.

Ebola can be transmitted through sweat, blood, saliva, semen and other bodily fluids. Once in the human body, the virus incubates for two to 21 days before causing fever, vomiting, diarrhea and eventually organ failure, followed by internal and external bleeding. It is believed to be contagious only after symptoms begin.

The UC Davis School of Veterinary Medicine’s One Health Institute is the home base for PREDICT members around the world who are assisting researchers in 35 partner labs – seven of which are in Africa – in identifying zoonotic diseases that may spread in their region. They take swabs from an area’s potential virus hosts, human or animal, and help diagnosticians there safely test the samples, either at their facility or back in the Davis lab. Once a virus is established as a risk, PREDICT helps inform local governments about how it might be transmitted and to recognize it quickly to prevent spillover to humans or limit its spread. PREDICT is a project of the United States Agency for International Development (USAID).

PREDICT does not have a partner lab set up in any of the countries experiencing an Ebola outbreak. It has, however, assisted governments in halting Ebola outbreaks before – twice in Uganda and once in the Democratic Republic of Congo.

Mazet sat down with The Sacramento Bee to discuss how the latest outbreak happened, and what people everywhere can learn from it.

In this particular outbreak, the virus has spread from human to human at an alarming rate, especially between victims and care providers. What kinds of interactions are causing that spread, and how likely is it to move outside of the affected areas?

There are ancient practices, and those contribute to the problem – things like bathing your dead. If they’re coated in sweat and/or blood and other things that have the virus in it, intimate contact like bathing the dead, kissing the dead; that spreads the virus.

That’s why people are saying this shouldn’t be such a big issue if it does come to the developed world, like here in the U.S., for a couple of reasons. We don’t have those ancient practices that are consistent with the spread. And also our health infrastructure is much, much better because we’re very sensitized and educated to this problem, so we’re going to be watching very vigilantly.

Media outlets have reported that hospitals in these countries are shutting down and bodies are being left on the street. Why is this happening?

They’re behaving in response to their fear as opposed to in response to knowledge. ... People come in in white suits and say, ‘Don’t bathe your dead. Bring them here to this hospital with me, who looks scary.’ And your poor husband, wife, grandmother has to die alone, and then they never come out of that hospital – that’s super scary.

They don’t have any good information flow, or infrastructure for that information flow. And so instead people are taking their dead and hiding them, or taking their sick and hiding them. That’s the new behavior. ... But getting to the hospital early and being treated well with supportive treatment like fluids, and being kept warm and hydrated and safe, we are seeing people survive. ... But in the places where it started the earliest and people got the most scared, those hospitals are becoming empty. No one is going to the hospital now, because they think it’s just a place to get sick.

More than 1,000 or so victims have succumbed to the virus to date. What are they actually dying of?

The last outbreak we responded to in DRC, the mortality rate was 90 percent. It was very quick and burned out. This one is behaving a bit differently and we have to wonder why. It’s maybe going just a little slower, so people start to be able to transmit the virus a little bit earlier than the people did in the last outbreak. That gives them more time to spread it before they know they are super sick. They don’t mean to be spreading it, but they might just have a little bit of a fever.

Malaria is very common in the area, people have fevers all the time. So they don’t assume that when they have a fever, they have Ebola. Now they may, because it’s so scary. But they don’t want to think they have Ebola so they still will be hopeful and think they have malaria, so they don’t stop interacting with others or moving around or doing those things. So that’s a big, big problem in this one.

What, if anything, can people in the United States do to help?

Their financial support can be helpful and their emotional support. But I think more what we need to do to prevent these things from happening in the future is commit to becoming more knowledgeable and supporting the knowledge base. If we know what’s out there and how it spreads, we know a lot more about how to not be fearful, and how to be prepared to be in this world that is one global village, if you will.

That’s what we need to think about. We need to think about our own health infrastructure, how to be good patients, how to not travel around when we’re sick. All of those things that maybe we don’t do now. ... We have to be thinking about being citizens of the world.